Therefore, we need to make a cautious note that any detrimental effect of hypertension with coexistent ovariectomy on hearts cannot be isolated to one specific factor, such as body weight changes, the estrogen receptor mechanism, dyslipidemia, lipid accumulation, insulin resistance, oxidative stress, the renin-angiotensin system, inflammation or unclear interacting factors. This evidence concerns the gene ESR1 and metabolic syndrome.